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ADHD experts respond to common questions about ADHD in children and adults…

“How can a child with attention deficit disorder (ADHD) focus intently for hours on a video game but be unable to make it through a single chapter in a textbook?”

Russell A. Barkley, Ph.D., responds: It seems paradoxical that children with ADHD can maintain focus on things that interest them but can’t stick with other things, like homework. Such behavior suggests that the child with ADHD is being willfully disobedient or that a lack of discipline and poor motivation are the problems. But such behavior is neither willful nor the result of poor parenting.

ADHD is not merely a disorder of attention, excess activity, or poor impulse control, though these features are usually the most conspicuous. The fact is, underneath lurks a profound disorder in the mental mechanisms that give humans the capacity for self-regulation.

ADHD disrupts a person’s ability to manage her behavior or to act with future consequences in mind. That’s why kids with ADHD are at their worst when they must complete tasks that have no immediate payoff. Goal-directed, future-oriented behavior demands that a person be able to motivate herself internally. This ability is described as willpower, self-discipline, ambition, persistence, determination, or drive. ADHD disrupts this mental mechanism, leaving those with the disorder “low on fuel” in motivating behavior toward future rewards.

If a task provides motivation and offers immediate gratification — such as playing a video game — a person with ADHD will have no problem sticking with it. Give these kids a task for which there is no external reinforcement or payoff, however, and their persistence falls apart. They jump from one uncompleted activity to another and become bored and disengaged.

To help a child with ADHD complete work when there is little immediate reward or interest in the task, adults can establish artificial rewards to sustain motivation. Earning tokens, chips, or other external rewards will help them persist. Without such rewards, they cannot themselves muster the intrinsic willpower to stick with a task. So, if your child with attention deficit disorder needs to read an entire chapter of a textbook, offer a reward for each segment of the work. Eventually, he will be able to sustain attention for longer periods, as tenacity becomes a habitual response to work.

“Isn’t ADHD just an excuse for a lack of discipline?”

Robert M.A. Hirschfeld, M.D., responds: The idea that willpower can solve all problems is as American as apple pie, but so are compassion, tolerance, and wisdom. Some people with diseases such as diabetes and hypertension can organize their lives to limit the effects of their disabilities. But some, no matter how hard they try, need insulin to break down sugar or medication to lower their blood pressure. We offer them support, and we do not blame them for their failure to “fix” themselves.

The same goes for ADHD.

Unfortunately, when it comes to brain disorders, such as ADHD, mood disorders, or other neurological conditions, a harmful attitude creeps in: the belief that attention deficit disorder, and other disorders originating in the mind, reflect “bad character” and that all it takes is more willpower to overcome them.

As a psychiatrist, and also as the father of a child with ADHD, I know how destructive this view is. Many people with mood disorders suffer for years because they’ve tried to make themselves feel better, and they still can’t function. Coworkers and spouses become frustrated and blame the sufferer when attempts to “jolly” a person out of the deep sadness of a mood disorder don’t work. Their lack of understanding adds guilt and shame to the long list of problems that people with a mood disorder cope with.

My son could not will himself to not have ADHD. Trying to get him to change his ADHD behaviors didn’t work. And had we stopped at that, his life would have been marked by frustration and failure. Without proper medical, psychological, and educational interventions, no amount of willpower could have helped. Fortunately, our continued interventions have enabled our son to shape his own destiny and experience many successes.

Challenges remain, and he’s needed our support — not our demands — to overcome them. We didn’t want our son to experience the fate of earlier generations of kids with ADHD who didn’t have the benefits of new knowledge and better science.

“Isn’t what you’re calling ADHD really just boys being boys?”

Carol Brady, Ph.D., responds: Many boys with ADHD are described with admiration by parents as being very active and curious. But it is the frequency and intensity of the “boyish” behavior that separates mere spiritedness from ADHD.

As I frequently see in my practice, “active and curious” may describe boys who can’t sit still long enough to complete a task. I’ve seen children go rapidly from one unfinished game to another — as many as 20 different starts in 30 minutes. Such behavior does not allow for the completion of any game, nor for the mastery of the critical social skills that are developed through play. In jumping from game to game, the child gets no practice in taking turns, dealing with frustration, playing by the rules, following through, and experiencing satisfaction from a job well done. Later on, these missing social skills can often result in friendless boys with poor self-images who are teased and ridiculed by others.

Denial of attention deficit disorder has lifelong consequences. I’ve worked with youngsters whose parents have to get up two hours before leaving in the morning in order to shepherd them through events that most children accomplish independently in 20 minutes. This isn’t just the dawdling of “boys being boys.” Because of their ADHD, these boys can’t organize the “getting ready” process in a way that allows them to shift from one task to another in a smooth sequence. Their behavior is disabling to themselves and the entire family.

Providing kids with ADHD with structure — and supporting a habit of following that structure — helps them develop self-management skills that offset the impulse to veer off track. People with ADHD who never learn these skills are in for a bumpy ride.

Dismissing typical ADHD behaviors as “boys being boys” denies kids the help they need to become independent, responsible teens and adults.

“Isn’t it unfair to other kids when those with ADHD get special accommodations, like untimed tests and shorter homework assignments?”

Clare B. Jones, Ph.D., responds: This question is one of the most frequently asked in my teacher workshops on ADHD. The answer requires understanding the distinction between fair and equal.

The dictionary defines fair as “just, even-minded, non-discriminatory.” Fair is helping someone do his best, with all the techniques a teacher can employ.

Equal means “treating everyone exactly the same.” If children have learning disabilities, treating them exactly the same as other kids is not fair. Accommodations for ADHD level the playing field for kids whose neurological makeup prevents them from being equal.

To illustrate the comparison between fair and equal, think of telling a child with hearing aids: “Remove your aids during this listening test. I must treat you equally. It is not fair for you to have amplified hearing.”

One student with ADHD told me, “With my disability, I feel I am trying to play ball with one hand on the bat, while everyone else has two. With an accommodation, it is like being told I can have two hands on the bat. Accommodations make me equal to my fellow players. I still have to keep my eye on the ball and hit it, and I still have to run the bases, but now I have a chance because I can use two hands on the bat.”

I’d like to see every teacher start the year by informing the class about accommodations. He should informally describe his expectations for the year and let the class know that modifications will be made for some students.

The teacher might say, “If one of your classmates needs an accommodation that you don’t need, I want you to know she will have that accommodation in this class, just as I will offer you every strategy you need if you are struggling. My goal is to help all of you learn. If that means one student gets 10 math problems and another gets 20, so be it. We all work together, but we all learn differently. The question in this room is not ‘How did you learn?’ but ‘How well did you learn?'”

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